Background and aims

Healthcare quality improvement “will lead to better patient outcomes (health), better system performance (care) and better professional development (learning)” (1). Co-production can be understood as an approach to healthcare quality improvement. In co-production, persons with illness, their family members and healthcare professionals co-plan, co-design, co-deliver and co-evaluate healthcare services (2). Co-learning about each other’s needs and how to jointly address care areas that need to improve is a crucial part of co-producing the best possible health (3). To date, few research projects focus on exploring how co-production of healthcare services and co-learning about what matters to healthcare professionals, persons with heart disease and their family members and might play out in a cardiac care setting. Thus, the overall aim of this thesis is to create learnings about how stakeholders can improve cardiac care services thorugh co-production. This abstract focuses on the professionals’ learnings when participating in co-produced healthcare quality improvements.

The first study in this thesis aimed at describing how a small-scale model for co-production, a Learning Café, might work in a cardiac care setting. To promote further co-production with persons with heart disease, the second study aimed at exploring the barriers to and facilitators of co-production. An Experience Based Co-Design methodology is used in the third and fourth study to facilitat e co-learning about joint healthcare quality improvement among persons with heart failure, their family members, and professionals. The aims of the third study were to identify experiences of life with heart failure and its care and to identify what change s to heart failure care can be proposed based on these experiences. In the fourth study, a small group with professionals and patient and family member representatives will co-design heart failure care improvements. Prerequisites for joint healthcare quality improvement projects will be explored.

Work integrated learning – a theoretical perspective

Work-integrated learning (WIL) is here understood as an educational philosophy to enhance the careers of professionals (4). Here hands-on work experience and lea rning in a real-world setting are combined (4). In this research, healthcare professionals’ careers are enhanced when working with healthcare quality improvement, co - produced with persons with heart disease and their family members. Hence, the professionals improve their knowledge about what matters to their patients and the family members and how to co -produce quality improvement initiatives that address these needs.

Context and methods

The research is set in cardiac care in the Highland health district in Region Jönköping County, Sweden as part of system-wide efforts to promote better health for persons with chronic disease (5). The research studies are conducted as a part of the healthcare professionals’ daily wok duties. Primary care centers and a hospit al serve the 115,000 inhabitants in the health district. Heart disease accounts for a major part of the disease burden in the health district’s elderly population. Although the concept of “co-production of healthcare services” has lately become more familiar to professionals in Region Jönköping County, few departments and primary care centers have fully adopted the concept.

Study I was an organizational case study (6). Healthcare professionals tailored a Learning Café intervention aimed at increasing the sense of security in everyday life among persons with atrial fibrillation. A Learning Café is a co - produced group education program during which atrial fibrillation patients’ questions about atrial fibrillation and its treatment were solicited and then answered by healthcare professionals (7). Data collection included measurements regarding sense of security in everyday life and focus group interviews exploring experiences and learnings from participating healthcare professionals and persons with atrial fibrillation. Study II was a focus group study (8). Healthcare professionals, persons with heart failure and their family members participated in focus group interviews aimed at exploring barriers to and facilitators of co -production of healthcare services. Interviews were analyzed using deductive qualitative content analysis and the COM-B model (9, 10). Study III and IV are based on an Experience Based Co-Design project (11) aimed at improving heart failure care. Data collection includes observations of healthcare consultations, filmed or audio recorded individual interviews and meeting minutes from stakeholders’ feedback events. Data is analyzed using reflexive thematic analysis (12).

Results

Professionals participating in the Learning Café intervention reported gaining lessons about person-centered care, what matters to persons with atrial fibrillation and how to work with healthcare quality improvement. These learnings were reported to enhance work satisfaction among professionals. Persons with atrial fibrillation reported a greater sense of security in everyday life when learning more about atrial fibrillation and its treatment (13). The second study (14) improved the professionals’ knowledge about barriers to and facilitators of co-production of healthcare services. Results implied that healthcare professionals are motivated to co -produce healthcare services. However, they had limited and varying understanding of co-production as a practice. Another barrier was the professionals’ unease with power sharing with patients and family members. In the third study (15), five overarching themes mirrored the experiences of life with heart failure and its care: “I struggle everyday”, “I don’t understand heart failure”, “Please, do not ignore me!”, “How can I get involved?” and “Heart failure care can improve!”. Persons with heart failure and their family members experienced a poor quality of life and were struggling to understand and apply information about heart failure and its care. To be recognized by professionals was experienced to be a crucial part of good quality care. However, participants often felt excluded from participation in care processes. These experiences translated into anticipated care improvements such as improved information, continuity of care, improved relations and communication and invitation to be involved in healthcare. Reflecting on these findings together with persons with heart failure and their family members, professionals gained knowledge about how to improve heart failure care to meet the needs of the service users.

Societal impact and relevance

This research promotes healthcare professionals’ work integrated learning about how to ackno wledge sick individuals as persons with individual needs, rather than patients defined by a disease. Second, research findings offer lessons regarding how healthcare services should improve to meet the needs of the persons living with disease.